Epinephrine of no benefit in cardiac arrest

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Survival Outcomes With the Introduction of Intravenous Epinephrine in the

Management of Out-of-Hospital Cardiac Arrest

Presented at the Singapore General Hospital 15th annual scientific meeting,

April 2006, Singapore; and at the Society for Emergency Medicine in

Singapore 8th annual scientific meeting, January 2007, Singapore.

Marcus Eng Hock Ong, MBBS, MPHa, Eng Hoe Tan, MBBS, MScb, Faith Suan

Peng Ng, MApp Statc, Anushia Panchalingham, RNc, Swee Han Lim, MBBS, FRCS

Edaf, Manning, MBBSd, Victor Yeok Kein Ong, MBBS, FRCS Ede,

Hoon Chin Lim, MBBS, MRCS Edaf, Yap, RNa, Lai Peng Tham, MBBS,

MMedg, Kheng Siang Ng, MBBS, MRCPh, Anantharaman Venkataraman, MBBS, FRCS

Eda

Received 21 February 2007; received in revised form 14 March 2007; accepted

26 March 2007. published online 18 May 2007.

Corrected Proof

Study objective

The benefit of epinephrine in cardiac arrest is controversial and has not

been conclusively shown in any human clinical study. We seek to assess the

effect of introducing intravenous epinephrine on the survival outcomes of

out-of-hospital cardiac arrest patients in an emergency medical services

(EMS) system that previously did not use intravenous medications.

Methods

This observational, prospective, before-after clinical study constitutes

phase II of the Cardiac Arrest and Resuscitation Epidemiology project.

Included were all patients who are older than 8 years, with nontraumatic

out-of-hospital cardiac arrest conveyed by the national emergency ambulance

service. The comparison between the 2 intervention groups for survival to

discharge was made with logistic regression and expressed in terms of the

odds ratio (OR) and the corresponding 95% confidence interval (CI).

Results

From October 1, 2002, to October 14, 2004, 1,296 patients were enrolled into

the study, with 615 in the pre-epinephrine and 681 in the epinephrine phase.

Demographic and EMS characteristics were similar in both groups. Forty-four

percent of patients received intravenous epinephrine in the epinephrine

phase. There was no significant difference in survival to discharge

(pre-epinephrine 1.0%; epinephrine 1.6%; OR 1.7 [95% CI 0.6 to 4.5];

adjusted for rhythm OR 2.0 [95% CI 0.7 to 5.5]); return of circulation

(pre-epinephrine 17.9%; epinephrine 15.7%; OR 0.9 [95% CI 0.6 to 1.2]), or

survival to admission (pre-epinephrine 7.5%; epinephrine 7.5%; OR 1.0 [95%

CI 0.7 to 1.5]). There was a minimal increase in scene time in the

epinephrine phase (10.3 minutes versus 10.7 minutes; 95% CI of difference

0.02 to 0.94 minutes).

Conclusion

We were unable to establish a significant survival benefit with the

introduction of intravenous epinephrine to an EMS system. More research is

needed to determine the effectiveness of drugs such as epinephrine in

resuscitation.